/NV Health Final Exam 1 | Latest 2025/ 2026 Update | Questions and Answers | 100% Correct| GRADED A (Verified Solutions).

/NV Health Final Exam 1 | Latest 2025/ 2026 Update | Questions and Answers | 100% Correct| GRADED A (Verified Solutions). Which law requires the applicant be notified before a consumer report is ordered: Fair Credit Reporting Act The Insuring Clause of an A&H policy usually states all of the following, EXCEPT: A. That insurance against loss is provided B. That a loss must result directly from stated accidents or sicknesses C. The method of premium payment D. The identities of the insurance company and the insured C. The method of premium payment Which of the following statements about Medicare is/are true? I. Payments are made directly to the hospital providing services rather than to the insured II. Benefits can continue beyond the hospitalization period Correct Answer: Both I and II The Misstatement of Age provision gives the insurance company the right to: A. Bring suit for fraud B. Cancel the contract C. Adjust benefits payable D. Reduce dividends payable C. Adjust benefits payable Which of the following statements about group A&H provisions and practices is/are true? I. Insurance company practices are generally less liberal under Group policies than under Individual policies II. Experience rating is generally utilized under Group policies Correct Answer: II only A&H insurance provides coverage for sickness and injury that includes which of the following benefits? I. Income benefits due to loss of time from work II. Benefit payments for hospital care Correct Answer: Both I and II Explanation: There are three different types of A&H insurance: 1) Medical Expense; 2) Disability Income and 3) AD&D. A&H is a general term including all three types. The part of a HMO policy, which provides for the claim to be shared between the insurer and the insured, is known as which of the following? A. Deductible B. Out of pocket maximum C. Co-pay D. Usual, customary and reasonable C. Co-pay Answers given by applicants to questions on applications for A&H insurance are considered which of the following? I. Representations II. Warranties I only - - Representations A&H coverage becomes effective when the: A. First premium has been paid and received in the insurance company's home office B. First premium has been paid and the application has been approved C. Producer delivers the policy to the insured D. Medical examination has been completed and the premium paid B. First premium has been paid and the application has been approved Which of the following policies can be written on a Non-cancelable and Guaranteed Renewable basis? I. A Major Medical Expense policy II. A Disability Income policy II only - A Disability Income policy Explanation: Major Medical policies are cancelable, meaning the insurer may cancel you at any time with proper advance notice. AD&D and Disability Income policies often voluntarily give up the right to cancel as a marketing strategy and may be non-cancelable, guaranteed renewable or both. An optionally renewable policy is renewable: A. If a physical exam is passed B. At the option of the insured C. Must be renewed D. At the option of the insurer D. At the option of the insurer Explanation: An optionally renewable policy is renewable entirely at the option of the insurer. The purpose of the Time Limit on Certain Defenses provision is to limit the time during which the: A. Insurance company can challenge the contract because of material misstatements in the application B. Insured must prove that she is insurable C. Insurance company is allowed to make any changes in the policy D. Insured can challenge the insurance company's denial of a claim A. Insurance company can challenge the contract because of material misstatements in the application The Pre-existing Condition exclusion in A&H insurance is designed to protect the insurance company against: A. Over-utilization B. Adverse selection C. Malingering D. Over insurance B. Adverse selection - (Person who is already sick purchase health insurance.) All have to sign an application, EXCEPT: Correct Answer: Beneficiary If a health underwriter discovers answers on an application are false, he will do all, EXCEPT: A. Notify MIB B. Return premium C. Notify producer D. Reject the application A. Notify MIB Explanation: The MIB collects a person's claims data/health history, tied to that person by their Social Security number. If an applicant lies on the application, the MIB will not be notified. It is probable that, if the insured lied on the application, the insurer will reject the application, notify the producer, who will then have the job of returning any premium paid to the applicant. Which of the following is an eligibility requirement for Social Security Disability Income benefits? A. Being at least age 50 B. At least 1 year of disability C. Currently insured status D. Fully insured status Correct Answer: Fully insured status Sandra has an occupation Disability Income policy with a change of occupation provision. She was a secretary and now is a white water rafting guide. She did not tell the insurance company of her change of occupation. She becomes disabled while guiding a rafting trip. What will her insurance company do? A. Deny the claim B. Void the policy C. Pay the claim D. Pay the claim, adjusting the benefits to what her premium should have purchased D. Pay the claim, adjusting the benefits to what her premium should have purchased The Fair Credit Reporting Act requires that: Correct Answer: The applicant for insurance be advised, in advance, that a consumer report may be requested In an A&H policy, an elimination period (waiting period) provision refers to the period: A. Between the first day of disability and the actual receipt of payment for the disability B. Between the effective date of the policy and the date on which any payments under the policy become due C. Between the first day of disability and the day to which the disability must continue before it can result in the insured receiving benefits D. During which any specific illness or accident is excluded from coverage Correct Answer: C. Between the first day of disability and the day to which the disability must continue before it can result in the insured receiving benefits Which of the following statements about the optional Change of Occupation provision in a Disability Income policy is true? A. It sets forth the rights and obligations of the insurance company and the insured in the event the insured engages in a more hazardous or less hazardous occupation B. It requires the insurance company to deny benefits, if the insured changes his occupation after the policy is in force C. It establishes the formula by which adjustments are made in policy premiums in the event the insured changes to a more hazardous occupation D. It voids the policy, if the insured suffers an otherwise-compensable loss while engaged in an illegal occupation A. It sets forth the rights and obligations of the insurance company and the insured in the event the insured engages in a more hazardous or less hazardous occupation Explanation: This optional provision allows the insurer to adjust benefits, up or down, if the insured has changed to a more hazardous or less hazardous occupation without notifying the insurance company. If an applicant applies for Health insurance, tells the truth to the best of his knowledge, pays the premium and receives a conditional receipt and no physical exam is required, coverage will start on: A. When insurer issued policy B. Policy delivery C. When underwriter approved application D. Date client signed application D. Date client signed application All of the following statements about preexisting conditions are true, EXCEPT: A. A preexisting condition, unless specifically excluded, is covered after the policy has been in force for a predetermined period of time B. Policies usually define sicknesses that occur within a specified period before the policy's effective date as Preexisting Conditions C. Policies usually define accidents that occur within 15 days after the effective date as Preexisting Conditions D. A definition of preexisting conditions is usually included in policies for reinforcement of the Time Limit on Certain Defenses provision Correct Answer: C. Policies usually define accidents that occur within 15 days after the effective date as Preexisting Conditions Explanation: There is no such thing as a preexisting accident. Preexisting conditions are conditions that existed prior to the date of application and are often excluded by the Probationary Period unless mentioned on the application. Clients wishing to set up a Health Savings Account (HSA) must already have which of the following? A. Health Reimbursement Account (HRA) B. Flexible Spending Account (FSA) C. High Deductible Health Plan D. Individual Sickness & Accident policy Correct Answer: C. High Deductible Health Plan Which of the following statements about the 10-day Free Look provision in an A&H policy is/are true? I. It allows the applicant to review the policy at no cost II. The 10-day period begins on the date of application Correct Answer: I only All of the following statements about sources of underwriting information are true, EXCEPT: A. An attending physician's statement is a good source of information B. A medical examination is typically used when benefits are large C. The contents of an inspection report cannot be disclosed to the applicant D. The application is typically the principal source of information C. The contents of an inspection report cannot be disclosed to the applicant Explanation: Contents of inspection reports may be disclosed to applicants, but the producer or company is under no obligation to give a copy of the report to the client. Under the Fair Credit Reporting Act, the producer or company is obligated to inform the client of the name and address of the reporting agency who furnished the report. Which of the following statements about Surgical Expense benefits is/are true? I. The amount on the benefit schedule is typically expressed in terms of the maximum benefit payable II. The benefits are typically subject to deductibles of $250 or more Correct Answer: I only Which of the following describes the fact that a Health insurance contract can only be changed by the insurance company? A. Adhesion B. Incontestable C. Aleatory D. Unilateral Correct Answer: D. Unilateral An insured owns a major medical policy with a $200 deductible and 80/20 co-insurance. The insured has a claim of $2,000. How much will the client receive from the insurance company? Correct Answer: $1,440 Any Death benefit under an A&H insurance contract is limited to deaths caused by which of the following? A. Accidental injury only B. Accidental injury, cardiovascular, and renal-impairment diseases C. Dread diseases D. Accidental injury and cardiovascular diseases only Correct Answer: A. Accidental injury only Which of the following statements about Group Disability Income benefit schedules is/are true? I. The most widely used benefit schedule is one that bases the amount of insurance on employees' earnings II. The Position Schedule specifies the amounts of insurance coverage for employees depending upon their employment positions Correct Answer: Both I and II Under a Guaranteed Renewable A&H policy, the insurance company may: A. Change any policy provision during the time the policy is in force B. Reduce the amount of insurance, if the insured's health declines C. Cancel the contract because of too many claims D. Change premium rates, if all other policies in that class within that state are changed D. Change premium rates, if all other policies in that class within that state are changed An insured has a Major Medical policy that calls for a flat $2,000 deductible and 80/20 participation. If the insured incurs medical expenses of $6,000, he would receive benefits of: A. $4,800 B. $2,000 C. $3,200 D. $5,000 Correct Answer: C. $3,200 Where would you look in a Medical Expense policy to determine what is covered? A. Eligible Expenses B. Conditions C. Insuring agreement D. Exclusions A. Eligible Expenses Under the terms of the typical Individual Accidental Death and Dismemberment policy, which of the following would qualify as a dismemberment? 解體 I. Nancy Wells loses all the fingers on her left hand in a factory accident II. Benjamin Green, who is right-handed, permanently loses the use of his right hand and arm as a result of an automobile accident Correct Answer: Neither I nor II An insured purchased Group Credit Disability insurance to cover a loan. Following an accident, the insured was disabled for seven months. Which of the following benefits were paid under the policy? I. The insured received Disability Income benefits II. The insured's creditor received an amount equal to the monthly loan payments A. I only B. II only C. Neither I nor II D. Both I and II Correct Answer: B. II only The insured's creditor received an amount equal to the monthly loan payments Explanation: Under a Group Credit Disability policy, the creditor is also the policyholder and the beneficiary. Payments made under the policy will be made to the creditor to reduce the amount owed. How many days must an insured wait after submission of Proof of Loss before taking legal action against an insurance company? Correct Answer: 60 Intentionally self-inflicted injuries are frequently excluded from coverage in which of the following types of policies? I. Medical Expense II. Disability Income Correct Answer: Both I and II Which A&H policy requires you to see a Dr. on their premises? A. Medicare Supplement B. PPO C. Indemnity plan D. HMO Correct Answer: HMO Which of the following statements about Medicaid is/are true? I. It is intended to provide medical assistance for certain categories of people who are needy II. The extent of covered costs varies among states Correct Answer: Both I and II I. It is intended to provide medical assistance for certain categories of people who are needy II. The extent of covered costs varies among states How are benefits usually stated in a Hospital Expense policy? I. Daily Room and Board benefits are expressed as a stated amount per day with a maximum number of days paid II. Miscellaneous Expense benefits are expressed as a multiple of the Daily Hospital benefit Correct Answer: Both I and II I. Daily Room and Board benefits are expressed as a stated amount per day with a maximum number of days paid II. Miscellaneous Expense benefits are expressed as a multiple of the Daily Hospital benefit The insured is required to submit a Notice of Claim to the insurance company within how many days after a loss? Correct Answer: 20 All of the following are ways in which you may pay an Accident and Health insurance policy premium, EXCEPT: A. Single B. Monthly C. Quarterly D. Annual Correct Answer: A. Single An applicant purchased an A&H policy on his wife that included an Accidental Death and Dismemberment benefit. He named himself as the beneficiary and specified that the Death benefits were to be payable to his son if he, the applicant, were to predecease his wife. In this situation, the applicant's son would be considered the: A. Contingent beneficiary B. Primary beneficiary C. Policy owner D. Insured Contingent beneficiary If an insured is disabled and receiving benefits under an A&H policy that provides payment to the insured for at least two years, at what intervals 間隔 must the insured provide notice of continuing loss? A. 3 months B. 12 months C. 9 months D. 6 months C. 6 months Language added to a Health policy that takes coverage away is: A. Waiver of Premium rider B. Guaranteed Insurability rider C. Impairment rider D. Cost of Living rider C. Impairment rider The Entire Contract provision in an A&H policy states which of the following? A. Specific rules, regulations, and procedures concerning the policy are maintained in the insurance company's home office B. The Entire Contract is on file with the producer and may be examined by the applicant at any time C. The policy delivered to the insured is a brief summary of the Entire Contract, which is on file with the appropriate state Department of Insurance D. The policy, with attached endorsements and other papers, constitutes the Entire Contract between the policy owner and the insurance company D. The policy, with attached endorsements and other papers, constitutes the Entire Contract between the policy owner and the insurance company Which of the following statements about the application form and the role of the producer in A&H insurance is/are true? I. In underwriting applicants, the producer must understand the importance of moral risk II. Problems with claims may occur because the producer failed to include all of the facts on the application form Correct Answer: Both I and II I. In underwriting applicants, the producer must understand the importance of moral risk II. Problems with claims may occur because the producer failed to include all of the facts on the application form Since only one party to an insurance contract makes an enforceable promise, insurance contracts are considered to be: A. Aleatory contracts B. Unilateral contracts C. Contracts of Utmost Good Faith D. Contracts of Adhesion Correct Answer: B. Unilateral contracts The purpose of the Co-insurance clause in Major Medical policies is to: A. Avoid costs associated with pregnancy and childbirth B. Force the insured to pay the larger claims from personal resources C. Motivate the insured to minimize unnecessary care D. Encourage the insured to satisfy the deductible C. Motivate the insured to minimize unnecessary care If an insurance company fails to notify an applicant that a reinstatement application was not approved, insurance will be placed back in force within how many days? A. 90 B. 60 C. 20 D. 45 Correct Answer: D. 45 Explanation: Although you cannot force an insurer to reinstate your lapsed policy, they must respond to your reinstatement application within 45 days or the policy is considered to be automatically reinstated by state law. Upon the date of reinstatement, a 10-day probationary period begins for sickness